Combined Z-plasty and phalangeal fillet for reconstruction of a large carpal defect following ablative oncologic surgery

A six-year-old Labrador Retriever was presented for management of a 2 x 2 cm cutaneous mass over the dorsal aspect of the carpus. A fine needle aspirate performed by the referring veterinarian was consistent with a mast cell tumour. The ipsilateral prescapular lymph node was enlarged. Preoperative staging did not reveal any evidence of metastasis. Wide excision of the mass and prescapular lymphadenectomy were performed. The large carpal wound was reconstructed using a combination of Z-plasty and phalangeal fillet using the first digit (dewclaw); about 20% of the original defect was allowed to heal by second intention. Histopathology was consistent with a grade II mast cell tumour with metastatic spread to the lymph node. Vinblastine and prednisolone adjuvant chemotherapy was instituted. Functional and cosmetic outcome were good; only a small 1cm area of alopecia persisted. The dog was disease-free 53 months after surgery. A combination of Z-plasty and a phalangeal fillet using the first digit was a successful treatment to reconstruct a large wound over the dorsal aspect of the carpus in this case.